近日，全球顶级医学期刊BMJ发表了题为“气候变化导致气温升高对传染病的影响”（The impact of increasing temperatures due to climate change on infectious diseases）的综述论文。该文章系统探讨了气温上升对登革热、疟疾等媒介传播疾病以及霍乱等经水传播疾病的影响，阐明了气候变化加剧气候敏感传染病负担的作用途径，并呼吁全球医疗公共卫生系统加大应对措施的力度。福建医科大学向建军教授和澳大利亚阿德莱德大学毕鹏教授为本文的共同通信作者，阿德莱德大学公共卫生学院研究员Olga Anikeeva为第一作者。
阅读目录
1
研究背景
2
数据来源
3
气温升高对病媒传播疾病和人畜共患疾病的影响
4
气温升高对食源性和水源性疾病的影响
5
应对气候变化对全球健康的挑战：国际机构和医疗保健系统的响应策略
6
总结
1. 研究背景
全球气候变化正在加剧高温热浪的频率和强度，这对传染病的传播有显著影响[1]。全球气温的升高和降雨模式的变化使得蚊子等媒介的繁殖环境更加有利，从而加速登革热、疟疾等疾病的传播[2]。同时，气候变化导致的洪水污染水源，增加了霍乱、沙门氏菌等水源性和食源性疾病的风险[3-4]。这篇综述阐述了气候变化对全球公共卫生的影响，呼吁全球卫生系统及医护人员采取积极措施，以应对气候变化带来的传染病挑战。
▲图1：气候变化对传染病传播模式的影响
2. 数据来源
这项研究通过对2024年2月至4月的文献检索得出，使用了“高温”、“气候变化”、“全球变暖”和“传染病”等关键词。纳入标准为同行评审过的英文文献，涵盖了高温对至少一种传染病的影响。文献类型包括系统评价、随机对照试验和观察性研究。表1总结了纳入研究的总体结果。
▲表1：关于高温对特定传染病影响的文献综述
3. 气温升高对虫媒传播疾病的影响
登革热：研究发现，温度每升高1°C，登革热感染风险增加13%[5]。降雨和湿度也会影响登革热的传播，但极端天气可能抑制蚊子的活动，抑制病毒传播[6]。
疟疾：气温升高和降雨模式变化会扩大蚊子栖息地，增加高海拔和寒冷地区的传播风险，这可能会增加数百万人面临疟疾的风险[7-8]。
日本脑炎：观察性研究一致报告了日本脑炎病例与气候变量（如温度、相对湿度和降雨量）之间存在正相关的关联[9-11]。例如，在印度亚热带潮湿地区进行的一项时间序列分析研究估计，日平均温度、降雨量和相对湿度每增加1个单位，日本脑炎的入院人数就会分别增加 22.2%，0.6%和 5.2%[12]。
西尼罗河热：气候变暖会加速蚊子和病原体的发育，提高西尼罗病毒的媒介能力[13-15]。在北美，每周平均最高气温每升高 5°C，西尼罗河病毒感染人数就会激增 32%～50% [16]。此外，最近的实验研究发现了气候变化对西尼罗病毒的影响存在与其他虫媒病毒出现共循环的现象[17-18]。
寨卡病毒：寨卡病毒通过蚊虫传播，气温在26～30°C时传播最为活跃[19]。哥伦比亚的一项生态学研究应用贝叶斯结构化加法回归模型来评估寨卡病毒疾病的高风险区域，发现该疾病与区域气象因素（温度、降雨量和相对湿度）之间存在显著的正相关[20]。
血吸虫病：血吸虫中间宿主蜗牛的繁殖、生存和传播，以及蠕虫在宿主内的发育，都对温度变化高度敏感[21]。适度的降水有利于蜗牛的繁殖，而强降雨可能会破坏蜗牛的栖息地并降低尾蚴的生存能力[22]。与气候变化相关的干旱、水盐度和 pH 值的变化也已被确定为血吸虫病传播的影响因素[23]。
利什曼病：中国在对 2005—2015 年间发生的两次利什曼病疫情进行的一项生态研究发现，较高的温度和较低的相对湿度会增加利什曼病的风险[24]。伊朗的一项研究使用地理信息系统和回归模型分析了人口、环境和地理数据，以确定影响利什曼病分布的环境和生态因素，其中气温升高和海拔较低、降雨量和湿度与病例增加相关[25]。
肾综合征出血热：一项针对中国19个城市的研究发现，最高气温每升高 1°C，肾综合征出血热病例就会增加1.6%; 每周降雨量增加 1 mm，病例就会随之增加0.2%; 平均相对湿度每增加1%，肾综合征出血热增加0.9%[26]。
4. 气温升高对食源性和水源性疾病的影响
霍乱：霍乱的爆发与气温上升和洪水密切相关，尤其是在缺乏清洁水源的地区，气温升高会使病原体在水中的存活时间延长[27]。
沙门氏菌病：沙门氏菌是常见的食源性病原体，35～37°C是沙门氏菌生长的最佳温度，高温促进其在食物中的传播[28]。研究表明，气温每升高1°C，感染风险增加3%～13%[29]。
弯曲杆菌病：温度升高与弯曲杆菌发病率的关系不如沙门氏菌明确，不同地区的研究结果不一[30]。在某些国家，如英格兰和德国，温度升高导致更多病例，而在其他地区，如韩国，未观察到显著关联[31-35]。
志贺菌病：研究表明，温度对志贺菌病传播的影响因地区而异[36]。在中国农村和城市地区，气候变化显著影响志贺菌病的传播[37-40]。
大肠杆菌感染：荟萃分析结果表明，温度每升高1°C，大肠杆菌感染风险增加8%～10%[38-41]。
军团菌病：据报道，气温升高会增加一些地区的军团菌发病率，但影响很小且研究结果不一致[42-45]。高温与强降雨或湿度相结合可能比单独使用温度更适合预测其风险[46-48]。
病毒性胃肠炎及轮状病毒感染：气候因素与病毒性腹泻之间的关联复杂，尚未完全明确[49]。某些研究显示温度升高减少轮状病毒感染[50]，但也有研究显示高温增加了感染风险[51]。
诺如病毒感染：寒冷气候有利于诺如病毒的存活，导致暴发风险增加，表明较低的温度可能有利于病原体在环境中的生存[52-53]。温度与诺如病毒感染之间的这种负相关（相对风险：0.85）显示滞后效应长达7周[54-55]。与温度不同，湿度和降雨量可能是非洲诺如病毒更敏感、更强的预测指标[56-58]。
手足口病: 研究表明，高温和低温（非最佳环境温度）都可能促进手足口病的传播，表现出温度光谱两端两个峰值的 M 形关系[59-61]。中国、越南和美国的一些系统评价和生态研究报告称，温度与手足口病之间存在正相关的关联，并与其他气候变量（如湿度、风速、气压和阳光）存在相互作用[62-67]。
5. 应对气候变化对全球健康的挑战：国际机构和医疗保健系统的响应
疾病监测、通知和信息共享：为了提高卫生系统对气候敏感性传染病的应对能力，开发综合监测和早期预警系统至关重要[68-69]。“One Health”倡议促进跨部门和跨地区合作，利用卫星遥感与地理信息系统技术识别传染病风险，尤其在中低收入国家，数字化疾病监测尤为重要。此外，病媒监测系统可以加强对病媒密度和分布的掌握，而人工智能与机器学习的应用更是可以提升数据整合与预测的精准性[70-71]。
▲图2：气候敏感传染病综合监测系统的需求
以风险地区为目标的监测和响应系统：全球气候预报与媒介监测数据的结合使得传染病暴发条件能够提前数周或数月预测。一项生态研究使用气候、人口和登革热通知数据集评估了哥伦比亚登革热早期预警信号模型的有效性，该数据集结合了温度、降水、湿度、海拔和人口密度数据，发现它在提前一到五个月成功检测到75%的疫情[72]。
医疗保健劳动力知识和能力：气候变化导致传染病的扩散，许多医护人员，尤其在过去不常处理此类疾病的地区，缺乏相关知识和经验。尽管大多数医学生意识到气候变化的健康影响，但在中国和埃塞俄比亚，分别超过80%和90%的学生认为自己未做好准备[73]。澳大利亚和印度的医护人员也面临类似的知识短缺[74-76]。因此，应该调整医疗保健专业教育和培训，使之更加关注极端高温对传染病风险的影响以及更广泛地关注气候变化对健康的影响。
医疗保健资源和协作：气候变化对传染病的影响对卫生资源的分配构成重大挑战，全球合作与跨部门合作至关重要[77]。低收入和中等收入国家由于资源不足，在实施气候相关政策方面面临更大困难[78-80]。应通过加大投资与培训，帮助这些国家提升传染病预防与管理能力尤为必要。同时，全球合作尤其是通过世卫组织，可以促进信息共享和经验交流，进一步增强各国的应对能力[81]。
6. 结论
气候变化加剧了病媒传播、食源性和水源性疾病的风险，如登革热、疟疾和霍乱等。全球卫生系统应采取积极的预防措施，加强疾病监测和早期预警系统建设，同时加大医疗教育和全球合作的力度，以应对气候变化带来的传染病挑战。进一步的研究还需关注气候变化与特定疾病之间的复杂关系，以制定更为有效的政策干预措施。
向上滑动阅览
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